Chemotherapy dosing in pediatric patient. Surapon Wiangnon Suddhavej Hospital Faculty of Medicine Mahasarakham University
|
|
- Abel Briggs
- 5 years ago
- Views:
Transcription
1 Chemotherapy dosing in pediatric patient Surapon Wiangnon Suddhavej Hospital Faculty of Medicine Mahasarakham University
2 Outline Principle of chemotherapy Use of BSA in chemotherapy dosing Pharmacokinetic consideration Chemotherapy dosing in special situation Carboplatin dosing using Calvert formula Obesity Amputees Down s syndrome Malnutrition Conclusion 2
3 Basic Principles of Cancer Therapy Cancer unregulated cellular proliferation Treatment modalities Surgery Radiation Drug therapy Treatment of choice for disseminated cancers, neoadjuvant 3
4 Obstacles to Successful Chemotherapy Toxicity to normal cells Absence of truly early detection Solid tumors respond poorly Limited drug access to tumor cells Heterogeneity of tumor cells Drug resistance 4
5 Strategies for Achieving Maximum Benefits from Chemotherapy Dose intensity Combination Maximum cell kill within acceptable toxicity Suppression of drug resistance Broad coverage against multiple cell lines Intermittent vs. continuous infusion Explain with cell cycle kinetics 5
6 Elsevier inc. item and derived items 2010 by saunders, an imprint of Elseveir Inc. 6
7 2012 American society of health system pharmacist 7
8 Principle of chemotherapy administration Non-Cell Phase Specific Agents Exert their cytotoxic effect throughout the cell cycle Cell kill is proportional to dose Cell Phase Specific Agents Toxic to the proportion of cells in the part of the cell cycle in which the agent is active Administer as a continuous infusion Begin therapy for kill resting cells, decrease tumor bulk, and recruit more cells into active division Follow with cell cycle-specific agents 8
9 Tumor growth kinetics Chemotherapy of benefit 9
10 Log kill kinetics Each course of chemotherapy kills a certain percent of cancer cell not number. Cytotoxic chemotherapy kills by 1st order kinetics Absolute zero: never reached Length of time between cycles: determined by the period of time it takes for normal tissues to rebound from drug toxicities 10
11 Optimizing dosing schedules Elsevier inc. item and derived items 2010 by saunders, an imprint of Elseveir Inc. 11
12 Dosing and Administration Based on the Patient s BSA Provides a more accurate estimate of crossspecies activity and toxicity May correlate with cardiac output and subsequent drug distribution and elimination 12
13 Body Surface Area Pinkel (1958) Retrospective analysis of therapeutic dose per unit weight vs. per unit BSA for 5 drugs Mechlorethamine, methotrexate, 6-mercaptopurine, actinomycin D, triethylene thiophosphoramide Similarity of the dosage per unit of BSA among animals and man Recommended BSA to be used for chemotherapy dosing Became the standard of dosing for chemotherapy until now 13 Cancer Res 1958;18:
14 Body Surface Area Which formula should we use? ASCO recommends any of the formula No evidence supporting one formula over another Mosteller formula: most commonly used Easy to use, remember J Clin Oncol ;30(13):
15 Body Surface Area No pharmacokinetic or efficacy studies to confirm Pinkel s findings Interpatient variability, in terms of pharmacokinetic parameters, still exist Physiological factors Intrinsic factors Environmental factors 15
16 The Oncologist 2007;12:
17 Body Surface Area Studies: correlation between PK of anticancer drugs and BSA of patient Clearance of several chemotherapy drugs were shown to be NOT correlated to BSA Eg. etoposide, ifosfamide, epirubicin, 5FU 17 Euro J Cancer 2002; 38;
18 Pediatric pharmacokinetic Children are not small adults The effects of chemotherapeutic agents on infants and young children are much different from those occurring in adolescents and adults Children differ from adults in each of the four pharmacokinetic stages 18
19 Pharmacokinetic considerations 4 PK stages: Absorption Distribution Metabolism Excretion 19
20 N Engl J Med 2003;349:
21 Ontogeny of Body Composition Premature Newborn 4 mo 12 mo 24 mo 36 mo Adult EC H 2 O IC H 2 O Protein Fat Other % of Total Body Weight Kaufman, Pediatric Pharmacology (Yaffe & Aranda, eds) pp , 1992
22 CNS Growth and Development 100 CNS Volume Adult Value [%] BSA Birth Age [yrs]
23 Acute Leukemia: Intrathecal dosage อาย (เด อน) Methotrexate (mg) Hydrocortisone (mg) Cytarabine (mg) <
24 Pediatric Chemotherapy Dosing In adults, dosing is usually based on BSA, a practice that is more historical than scientific Because of differences in PK properties, the chemotherapy dosage derived from adult studies may not accurately predict similar drug exposure in pediatric patients 24
25 Pediatric Chemotherapy Dosing When to use BW instead? Ratio of BSA to BW is significantly higher in infants and drastically lessens as a child grows Infants and young children, BSA can greatly overestimate the dose needed to achieve a desired AUC, whereas BW may be a more accurate predictor of drug exposure 25
26 Pediatric Chemotherapy Dosing Rule of 30 : used to adjust a dose from mg/m 2 to mg/kg (Pt with BSA of 1 m 2 weighs approximately 30 kg) This conversion can be problematic, since it sometimes leads to a large variability in calculated chemotherapy dose 26
27 Protocol name: ThaiPOG-HB-13LR Protocol for Low risk hepatoblastoma Drug Desired dose Route Day Total dose Cisplatin (CDDP) X 4 Cycles 80 mg/m 2 /dose IV drip in 24 hr mg/m 2 Give chemotherapy q 2 weeks, ANC > 1,000 and platelet > 100,000 before start chemotherapy Blood for LFT, AFP before each course and record liver size every course If BW < 12 kg, calculate chemotherapeutic agent dose per kg [(desired dose/ 30) xbw] G-CSF is not necessary, unless the patient has febrile neutropenia from the previous course 27
28 Pediatric Chemotherapy Dosing BSA-based dosing can be overestimated Different studies evaluating the same drug and tumor type may determine to use BWbased dosing in pediatric patients based on age (<12 months or <3 years) or weight (<10, 12, or 30 kg) 28
29 ThaiPOG-WT-1301: Favorable histology ความถ ต วยา ขนาดและว ธ ใช Day Cycle ท ก 3 wk ท ก 1 wk ท ก 3 wk Actinomycin-D Age < 12 months mg/kg IV Age 12 months mg/kg IV BW 30 kg 1.35 mg/m 2 IV (Maximum dose 2.3 mg) Vincristine1 Age < 12 months mg/kg IV Age 12 months 0.05 mg/kg IV BW 30 kg 1.5 mg/m 2 IV (Maximum dose 2 mg) Vincristine2 Age < 12 months mg/kg IV Age 12 months mg/kg IV BW 30 kg 2 mg/m 2 IV (Maximum dose 2 mg) 1 Wk 0, 3, 6, 9, 12, 15, 18 1 Wk Wk 12, 15, 18 29
30 Pediatric Chemotherapy Dosing In neonates, dose reductions of up to 50% are commonly made to offset the immaturity of elimination pathways Dose reductions are applied inconsistently across treatment regimens and protocols Often are based on toxicity observed in previous studies, rather than on true PK data 30
31 Carboplatin Cleared 70% by glomerular filtration Carboplatin plasma clearance is linearly related to GFR Clearance of Carboplatin correlates better with AUC than with BSA J Clin Oncol 1989;7:
32 Carboplatin Dosing Formula based on renal function is derived Dose (mg) = target AUC x (GFR + 25) AUC correlates with thrombocytopenic nadir AUC of 4-6 for 3 weekly regimen gave rise to manageable hematological toxicity AUC of 2 for weekly regimen J Clin Oncol 1989;7:
33 FDA dose capping recommendations GFR used in calvert formula should not exceed 125ml/min AUC 6 = 900 mg AUC 5 = 750 mg AUC 4 = 600 mg Dosing above the FDA dose capping recommendations is rarely seen with the above dosing recommendations 33
34 Dosing chemotherapy in obesity Use of actual body weight for dosing chemotherapy Crucial when treatment goal is to cure No evidence of increased short-or long-term toxicity Myelosuppression is the same or less in obese patients with cancer than in non-obese patients Reduced doses may result in poorer disease-free and overall survival rates 34
35 Dosing chemotherapy in obesity Use actual body weight (ABW) in calculating chemotherapy dose regardless of obesity status for oral and intravenous routes Cap the Vincristine to a maximum of 2 mg in CHOP and CVP Cap Bleomycin in BEP 35
36 Dosing chemotherapy in amputees Drug distribution Change in body composition Size of vascular system Cardiac output may change Drug metabolism Unlikely to change Drug excretion Unlikely to change 36
37 Dosing chemotherapy in amputees Different methods, so confer with protocol guidelines Use original weight and height prior to amputation to calculate BSA Use post-surgical weight and original height to calculate BSA 37
38 Dosing chemotherapy in amputees Am J Hosp Pharm 1984: 41:
39 Protocol ThaiPOG-OS-18-MTX Drug Dose Route A: Doxorubicin 37.5 mg/m 2 /day IV x 2 days (IV slowly push) P: Cisplatin 60 mg/m 2 /day IV over 6 hours x 2 days M: HD MTX 12 gm/m 2 /day IV over 4 hour (max 20 gm) Leucovorin 15 mg/m 2 /dose IV q 6 h, starting at hr 24 of MTX infusion ( > 8 doses) การร กษา osteosarcoma ผ ป วยจะได ร บยา neoadjuvant chemotherapy เพ อลด ขนาดของก อนเน องอกและด การตอบสนองของก อนเน องอกต อยาเคม บาบ ด ซ งเป น prognostic factor หน ง และยาเคม บาบ ดสามารถควบค มเน องอกท metastasis หล งการผ าต ดผ ป วยจะได ร บ adjuvant chemotherapy ต ออ กระยะ Amputee chemotherapy dosage (ThaiPOG): 39
40 Down s syndrome Down syndrome or constitutional trisomy 21 Linked to leukemia Trisomy 21 likely contributes to the development of GATA1 mutations Chromosome 21-localized genes Cystathionine-β- synthase (CBS) Zinc-copper superoxide dismutase(sod1) Folate metabolism 40
41 Down s syndrome Effect Impaired cytidine deaminase activity Increased superoxide dismutase (SOD) activity Impaired carbonyl reductase 1 (CBR1) activity Increased reduced folate carrier(slc19a1) 41
42 Down s syndrome Treatment-related toxicity: more frequent and severe Treated with corticosteroids: increased risk of developing hyperglycemia May consider decrease the dose or closely monitor toxicity from therapy 42
43 Protocol name: ThaiPOG-AML-DS Reference: COG AAML0431 Protocol for: AML-DS Drug Route Dosage Days Cytarabine (ARA-C) IV continuous 200 mg/m 2 /day or 6.67 mg/kg/day if age < 36 mo Doxorubicin (DOX) IV continuous 20 mg/m 2 /day or 0.67 mg/kg/day if age < 36 mo Thioguanine (6TG) PO 50 mg/m2/dose PO BID 1.65 mg/kg/dose PO BID if age < 36 mo Days 1-4 Days 1-4 Days 1-4 Intrathecal Cytarabine (IT ARA-C) IT Age (mo) < ARA-C 20 mg 30 mg 50 mg 70 mg Day 1 Note # For CNS 3 patient: give twice weekly IT cytarabine until CNS is clear for 2 consecutive times. Patient with refractory CNS leukemia following 6 doses of therapy will be managed according to institutional protocol หากสถาบ นใดไม ม 6TG สามารถต ด 6TG ออกได โดยให แค เพ ยง cytarabine และ doxorubicin 43
44 Special consideration There was a significant relationship between the prevalence of treatment-induced neutropenia and malnutrition (South African J Clin Nutr 2017) Malnourish patient: BW < 12 kg, chemo dose 2/3
45 Protocol name: ThaiPOG-HOD-1801 Reference: COG AHOD 0431 Protocol for: Low Risk Hodgkin Disease Drug Route Dosage Days Doxorubicin (DOX) IV push over 5 minutes 25 mg/m 2 /dose 1, 2 Bleomycin (BLEO) IV over 10 minutes 5 Units/m 2 /dose 10 Units/m 2 /dose* 1 8* Vincristine (VCR) IV push over 1 minute 1.4 mg/m 2 /dose** 1, 8 Etoposide (ETOP) IV over 1-2 hours 125 mg/m 2 /dose 1, 2, 3 **Max dose for vincristine 2.8 mg/dose 45
46 Conclusion Dose based on BSA may not be the best method for every drug Use actual body weight to dose chemotherapy for obese patients There is a lack of evidence and guideline for dosing of chemotherapy in amputees However, based on the theoretical PK of drugs in amputees and the intention of cure, not unreasonable to use pre-amputation weight and height 46
47 Conclusion Multiple factors complicate the treatment of cancer in pediatric patients Clinicians must take these many factors into account when designing chemotherapy regimens for pediatric patients Ultimately, these considerations will enable better care and monitoring of pediatric patients with cancer 47
Foo Koon Mian Pharmacy Resident National University of Singapore Hematology / Oncology Pharmacy Residency Program. 4th APOPC November 2012
Foo Koon Mian Pharmacy Resident National University of Singapore Hematology / Oncology Pharmacy Residency Program 4th APOPC 2012 1-3 November 2012 1 Outline Use of BSA in chemotherapy dosing Chemotherapy
More informationAdjuvant/Curative/Neo-adjuvant High Grade and Burkitt s Lymphoma Regimens. High Grade Lymphoma
Adjuvant/Curative/Neo-adjuvant High Grade and Burkitt s Lymphoma Regimens The following table lists the evidence-informed regimens (both IV and non-iv) for high grade and Burkitt s lymphoma used in the
More informationECN Protocol Book. Generic Chemotherapy Protocol Guidelines. ECN_Protocol_Book_generic chemotherapy protocol guidelines guidelines_1
ECN Protocol Book Generic Chemotherapy Protocol Guidelines Name of person presenting document: Reason for document development: Names of development team: Specify groups of staff to whom the document relates:
More informationANAPLASTIC LARGE CELL LYMPHOMA TREATMENT ROAD MAP (Modified ALCL99)
ANAPLASTIC LARGE CELL LYMPHOMA TREATMENT ROAD MAP (Modified ALCL99) CLASSIFICATION OF TREATMENT GROUPS: 1. Isolated Skin lesions, < 5 skin lesions. Treatment course: ( No treatment, wait and see approach)
More informationGemcitabine + Cisplatin Regimen
Gemcitabine + Cisplatin Regimen Available for Routine Use in Burton in-patient Derby in-patient Burton day-case Derby day-case Burton community Derby community Burton out-patient Derby out-patient Indication
More informationNCCP Chemotherapy Regimen. Carboplatin (AUC 2) Weekly with Radiotherapy (RT)
INDICATIONS FOR USE: Carboplatin (AUC 2) Weekly with Radiotherapy (RT) Regimen Code 00419a *Reimbursement Indicator INDICATION ICD10 Chemoradiation treatment for stage III and IV locally advanced C11 nasopharyngeal
More informationRenal Function and Associated Laboratory Tests
Renal Function and Associated Laboratory Tests Contents Glomerular Filtration Rate (GFR)... 2 Cockroft-Gault Calculation of Creatinine Clearance... 3 Blood Urea Nitrogen (BUN) to Serum Creatinine (SCr)
More informationClinical Trials. Ovarian Cancer
1.0 0.8 0.6 0.4 0.2 0.0 < 65 years old 65 years old Events Censored Total 128 56 184 73 35 108 0 12 24 36 48 60 72 84 27-10-2012 Ovarian Cancer Stuart M. Lichtman, MD Attending Physician 65+ Clinical Geriatric
More informationPharmacotherapy Issues in the Pediatric Population
Pharmacotherapy Issues in the Pediatric Population Continuing Professional Pharmacy Development Dr. Shane Pawluk, PharmD Dr. Andrea Cartwright, PharmD Dr. Maryam Khaja March 26, 2014 Outline Didactic Session
More informationCARBOplatin (AUC5) and Etoposide 100mg/m 2 Therapy-21 day
INDICATIONS FOR USE: CARBOplatin (AUC5) and 100mg/m 2 Therapy-21 day ICD10 Regimen Code INDICATION Small cell lung cancer (SCLC) extensive disease C34 00271a *If a reimbursement indicator (e.g. ODMS, CDS
More informationGazyva (obinutuzumab)
STRENGTH DOSAGE FORM ROUTE GPID 1000mg/40mL Vial Intravenous 35532 MANUFACTURER Genentech, Inc. INDICATION(S) Gazyva (obinutuzumab) is a CD20- directed cytolytic antibody and is indicated, in combination
More informationCISPLATIN Chemo-radiation regimen Gynaecological Cancer
Systemic Anti Cancer Treatment Protocol CISPLATIN Chemo-radiation regimen Gynaecological Cancer PROCTOCOL REF: MPHAGYNCIX (Version No: 1.0) Approved for use in: Locally advanced cervical cancer (adjuvant/curative)
More informationCisplatin + Etoposide + Thoracic Radiotherapy (TRT) INDICATIONS FOR USE:
Cisplatin + Etoposide + Thoracic Radiotherapy (TRT) INDICATIONS FOR USE: Protocol INDICATION ICD10 Code Small cell lung cancer (SCLC) limited disease C34 00279a ELIGIBILTY: Indications as above ECOG 0-2
More informationCarboplatin Time to Drop the Curtain on the Dosing Debate
Carboplatin Time to Drop the Curtain on the Dosing Debate Jon Herrington, Pharm.D., BCPS, BCOP Judith Smith, Pharm.D., BCOP, CPHQ, FCCP, FISOPP Scott Soefje, Pharm.D., MBA, BCOP Heimberg J, et al. N Engl
More information1. FBE,UEC, LFT 2. USS of eyes confirm intraocular origin, possible calcifications. 3. CT(if available) of eyes and head
Retinoblastoma PNG V2 Treatment Guidelines for PNG Retinoblastoma 01V1 Current aim of treatment is to preserve life, vision preservation is secondary at this time. Retinoblastoma remains intra ocular and
More informationSAALT3W Sarcoma Dr. Meg Knowling. Protocol Code Tumour Group Contact Physician
BCCA Protocol Summary for Etoposide, Ifosfamide-Mesna (SAIME) Alternating with vincristine, DOXOrubicin and Cyclophosphamide (with or without Mesna)(SAVAC or SAVACM) with Filgrastim Support at a THREE
More informationNCCP Chemotherapy Protocol. Carboplatin Monotherapy-21 days
Carboplatin Monotherapy-21 INDICATIONS FOR USE: INDICATION ICD10 Protocol Code First line adjuvant therapy of ovarian carcinoma of epithelial origin primary peritoneal carcinoma fallopian tube cancer C56
More informationASSESSMENT OF THE PAEDIATRIC NEEDS CHEMOTHERAPY PRODUCTS (PART I) DISCLAIMER
European Medicines Agency Evaluation of Medicines for Human Use London, September 2006 Doc. Ref.: EMEA/384641/2006 ASSESSMENT OF THE PAEDIATRIC NEEDS CHEMOTHERAPY PRODUCTS (PART I) DISCLAIMER The Paediatric
More informationDocetaxel. Class: Antineoplastic agent, Antimicrotubular, Taxane derivative.
Docetaxel Class: Antineoplastic agent, Antimicrotubular, Taxane derivative. Indications: -Breast cancer: -Non small cell lung cancer -Prostate cancer -Gastric adenocarcinoma _Head and neck cancer Unlabeled
More informationInternational Pleuropulmonary Blastoma (PPB) Treatment and Biology Registry. Types I, II and III PPB
CHILDREN S HOSPITALS AND CLINICS of MINNESOTA 2525 Chicago Avenue South Minneapolis, Minnesota 55404, USA International Pleuropulmonary Blastoma (PPB) Treatment and Biology Registry Types I, II and III
More informationR-ICE Regimen- Rituximab, Etoposide, Ifosfamide (with MESNA), Carboplatin (+ Depocyte if CNS involvement)
R-ICE Regimen- Rituximab, Etoposide, Ifosfamide (with MESNA), Carboplatin (+ Depocyte if CNS involvement) Available for Routine Use in Burton in-patient Derby in-patient Burton day-case Derby day-case
More informationCARBOplatin (AUC4-6) Monotherapy-21 days
INDICATIONS FOR USE: CARBOplatin (AUC4-6) Monotherapy-21 days INDICATION ICD10 Regimen Code First line adjuvant therapy of ovarian carcinoma of epithelial origin C56 00261a primary peritoneal carcinoma
More informationTHE CLATTERBRIDGE CANCER CENTRE NHS FOUNDATION TRUST. Systemic Anti Cancer Treatment Protocol. EDP + mitotane
Systemic Anti Cancer Treatment Protocol EDP + mitotane PROCEDURE REF: MPHAHANEDP (Version No: 1.0) Approved for use in: Symptomatic treatment for advanced (unresectable, metastatic or relapsed) adrenocortical
More informationCarboplatin / Gemcitabine Gynaecological Cancer
Systemic Anti Cancer Treatment Protocol Carboplatin / Gemcitabine Gynaecological Cancer PROCTOCOL REF: MPHAGYNCAG (Version No: 1.0) Approved for use in: Recurrent/metastatic endometrial carcinoma Previously
More informationBurkitt s Lymphoma or DLBCL with adverse features PATIENTS WITH GOOD PERFORMANCE STATUS
Regimen R-CODOX M Indication Burkitt s Lymphoma or DLBCL with adverse features Therapeutic Intent Radical/Curative PATIENTS WITH GOOD PERFORMANCE STATUS Day Medication Dose Route Administration Details
More information2.07 Protocol Name: CHOP & Rituximab
2.07 Protocol Name: CHOP & Rituximab Indication Intermediate and high grade, B-cell non-hodgkins lymphoma expressing CD20. Second or third line therapy for low grade, B cell non- Hodgkins lymphoma expressing
More informationBC Cancer Protocol Summary for Adjuvant Therapy for Breast Cancer Using DOCEtaxel, CARBOplatin, and Trastuzumab (HERCEPTIN)
BC Cancer Protocol Summary for Adjuvant Therapy for Breast Cancer Using DOCEtaxel, CARBOplatin, and Trastuzumab (HERCEPTIN) Protocol Code Tumour Group Contact Physician BRAJDCARBT Breast Dr. Susan Ellard
More informationWeekly CARBOplatin (AUC2) PACLitaxel 50mg/m 2 Therapy with Radiotherapy
Weekly CARBOplatin (AUC2) PACLitaxel 50mg/m 2 with Radiotherapy INDICATIONS FOR USE: Regimen *Reimbursement INDICATION ICD10 Code Status Stage III Non small cell lung cancer (NSCLC) C34 00309a Hospital
More informationBCCA Protocol Summary for Treatment of Advanced Squamous Cell Carcinoma of the Head and Neck Cancer Using Fluorouracil and Platinum
BCCA Protocol Summary for Treatment of Advanced Squamous Cell Carcinoma of the Head and Neck Cancer Using Fluorouracil and Platinum Protocol Code: Tumour Group: Contact Physician: HNAVFUP Head and Neck
More informationCombined drug and ionizing radiation: biological basis. Prof. Vincent GREGOIRE Université Catholique de Louvain, Cliniques Universitaires St-Luc
Combined drug and ionizing radiation: biological basis Prof. Vincent GREGOIRE Université Catholique de Louvain, Cliniques Universitaires St-Luc Pelvic radiation with concurrent chemotherapy compared with
More informationManagement of Stage Ic-IV Malignant Ovarian Germ Cell Tumours
Management of Stage Ic-IV Malignant Ovarian Germ Cell Tumours Michael J Seckl Charing Cross Hospital Campus of Imperial College NHS Healthcare Trust Imperial College London, UK 9-12th June 2010 Caravaggio
More informationAnticancer Drugs. University of Sulaimani Faculty of Medical Sciences School of Pharmacy Pharmacology & Toxicology Dept.
University of Sulaimani Faculty of Medical Sciences School of Pharmacy Pharmacology & Toxicology Dept. Anticancer Drugs Prepared by: Hussein A. Muhammad MSc cancer Pharmacology hussein.al-barazanchi@kissr.edu.krd
More informationMASCC Guidelines for Antiemetic control: An update
MASCC / ISOO 17 th International Symposium Supportive Care in Cancer June 30 July 2, 2005 / Geneva, Switzerland MASCC Guidelines for Antiemetic control: An update Sussanne Börjeson, RN, PhD Linköping University,
More informationDrug dosing in Extremes of Weight
Drug dosing in Extremes of Weight The Plump & Heavy versus The Skinny & Light Maria Minerva P. Calimag, MD, MSc, PhD, DPBA, FPSECP PROFESSOR Departments of Pharmacology, Anesthesiology and Clinical Epidemiology
More informationProspective study evaluating a strategy of surgery alone and surveillance in FIGO stage I malignant ovarian germ cell tumor (KGOG 3033)
Prospective study evaluating a strategy of surgery alone and surveillance in FIGO stage I malignant ovarian germ cell tumor (KGOG 3033) Investigators/Collaborators: Jeong-Yeol Park, M.D., Ph.D. Department
More informationegfr 34 ml/min egfr 130 ml/min Am J Kidney Dis 2002;39(suppl 1):S17-S31
Update on Renal Therapeutics Caroline Ashley Lead Pharmacist Renal Services UCL Centre for Nephrology, Royal Free Hospital, London Kongress für Arzneimittelinformation January 2011 What are we going to
More informationClinical Policy: Levoleucovorin (Fusilev) Reference Number: ERX.SPA.181 Effective Date:
Clinical Policy: (Fusilev) Reference Number: ERX.SPA.181 Effective Date: 01.11.17 Last Review Date: 11.18 Revision Log See Important Reminder at the end of this policy for important regulatory and legal
More informationStandard Regimens for Haematology
Regimens for Haematology ChlVPP Chlorambucil 6mg/m 2 PO D1 to 14 Vinblastine 6mg/m 2 (max 10mg) IV on D1 & 8 Procarbazine 100mg/m 2 PO on D1 to 14 Prednisolone 40mg PO D1 to 14 ABVD Doxorubicin 25mg/m
More informationWhat is a hematological malignancy? Hematology and Hematologic Malignancies. Etiology of hematological malignancies. Leukemias
Hematology and Hematologic Malignancies Cancer of the formed elements of the blood What is a hematological malignancy? A hematologic malignancy is a malignancy (or cancer) of any of the formed elements
More informationNCCP Chemotherapy Regimen
Dose Dense DOXOrubicin, Cyclophosphamide (AC 60/600) 14 day followed by PACLitaxel (175) 14 day and Trastuzumab Therapy (DD AC-TH) Note: There is an option for Dose Dense DOXOrubicin, cyclophosphamide
More informationBleomycin, Etoposide and CISplatin (BEP) Therapy
Bleomycin, Etoposide and CISplatin (BEP) Therapy INDICATIONS FOR USE: INDICATION ICD10 Regimen Code Adjuvant treatment of high risk (vascular invasion C62 00300a carcinoma) stage 1 nonseminoma germ cell
More informationUse ideal body weight (IBW) unless actual body weight is less. Use the following equation to calculate IBW:
Amikacin is a partially restricted (amber) antibiotic for the treatment of infections due to gentamicin resistant Gram negative bacilli or as advised by microbiology. As with other aminoglycosides, therapeutic
More informationLYIVAC (Magrath B) + R (rituximab) [To be used after LYCODOX-M (Magrath A) + R]
Page 1 of 7 PPO FOR THE TREATMENT OF BURKITT LYMPHOMA AND LEUKEMIA LYIVAC (Magrath B) + R (rituximab) [To be used after LYCODOX-M (Magrath A) + R] DAY DATE CHEMOTHERAPY 1 Start signature sheet and prednisolone
More informationThis is a controlled document and therefore must not be changed or photocopied L.80 - R-CHOP-21 / CHOP-21
R- / INDICATION Lymphoma Histiocytosis Omit rituximab if CD20-negative. TREATMENT INTENT Disease modification or curative depending on clinical circumstances PRE-ASSESSMENT 1. Ensure histology is confirmed
More informationProtocol Abstract and Schema
Protocol Abstract and Schema A Phase I Trial of p28 (NSC745104), a Non-HDM2 mediated peptide inhibitor of p53 ubiquitination in pediatric patients with recurrent or progressive CNS tumors Description and
More informationClinical Policy: Dolasetron (Anzemet) Reference Number: ERX.NPA.83 Effective Date:
Clinical Policy: (Anzemet) Reference Number: ERX.NPA.83 Effective Date: 09.01.18 Last Review Date: 08.18 Revision Log See Important Reminder at the end of this policy for important regulatory and legal
More informationUpdate on Neoadjuvant Chemotherapy (NACT) in Cervical Cancer
Update on Neoadjuvant Chemotherapy (NACT) in Cervical Cancer Nicoletta Colombo, MD University of Milan-Bicocca European Institute of Oncology Milan, Italy NACT in Cervical Cancer NACT Stage -IB2 -IIA>4cm
More informationPractical Application of PBPK in Neonates and Infants, Including Case Studies
Practical Application of PBPK in Neonates and Infants, Including Case Studies Presented at the conference : Innovative Approaches to Pediatric Drug Development and Pediatric Medical Countermeasures: A
More informationClinical Guidelines for Managing Topotecan-Related Hematologic Toxicity
Clinical Guidelines for Managing Topotecan-Related Hematologic Toxicity DEBORAH ARMSTRONG, SEAMUS O REILLY Johns Hopkins Oncology Center, Baltimore, Maryland, USA Key Words. Topotecan Topoisomerase I inhibitor
More informationCarboplatin + Paclitaxel Cancer of the Cervix
Carboplatin + Paclitaxel Cancer of the Cervix Background: Topotecan in combination with cisplatin is recommended as a treatment option for women with recurrent or stage IVB cervical cancer only if they
More informationTCHP Docetaxel, Carboplatin, Trastuzumab, Pertuzumab Neoadjuvant Protocol
Systemic Anti Cancer Treatment Protocol TCHP Docetaxel, Carboplatin, Trastuzumab, Pertuzumab Neoadjuvant Protocol PROTOCOL REF: MPHATCHP (Version No: 1.0) Approved for use in: Neoadjuvant breast: The neoadjuvant
More informationCisplatin Doxorubicin Sarcoma
Systemic Anti Cancer Treatment Protocol Cisplatin Doxorubicin Sarcoma PROCEDURE REF: MPHACISDOX (Version No. _1.0) Approved for use in: Osteosarcoma Palliative / advanced disease Not suitable for PAM schedule
More informationMANAGEMENT OF ACUTE LYMPHOBLASTIC LEUKEMIA. BY Dr SUBHASHINI 1 st yr PG DEPARTMENT OF PEDIATRICS
MANAGEMENT OF ACUTE LYMPHOBLASTIC LEUKEMIA BY Dr SUBHASHINI 1 st yr PG DEPARTMENT OF PEDIATRICS Introduction The management of ALL, the most common childhood malignancy (1/3 rd of all malignancy), has
More informationMedicinae Doctoris. One university. Many futures.
Medicinae Doctoris The Before and The After: Can chemotherapy revise the trajectory of gastric and esophageal cancers? Dr. David Dawe MD, FRCPC Medical Oncologist Assistant Professor Disclosures None All
More informationRituximab-CHOP Regimen - ENRICH Study
Rituximab-CHOP Regimen - Study Randomised, open label study of Rituximab/Ibrutinib vs Rituximab/Chemotherapy in older patients with untreated mantle cell lymphoma ***See protocol for further details***
More information5-Fluorouracil, epirubicin 100 and Cyclophosphamide (FEC 100) Therapy
5-Fluorouracil, epirubicin 100 and Cyclophosphamide (FEC 100) Therapy INDICATIONS FOR USE: Regimen INDICATION ICD10 Code Neoadjuvant treatment for breast carcinoma C50 00265a Adjuvant treatment for breast
More informationSubject: Palonosetron Hydrochloride (Aloxi )
09-J0000-87 Original Effective Date: 02/15/09 Reviewed: 07/09/14 Revised: 03/15/18 Subject: Palonosetron Hydrochloride (Aloxi ) THIS MEDICAL COVERAGE GUIDELINE IS NOT AN AUTHORIZATION, CERTIFICATION, EXPLANATION
More informationGASTRIC & PANCREATIC CANCER
GASTRIC & PANCREATIC CANCER ASCO HIGHLIGHTS 2005 Fadi Sami Farhat, MD Head of Hematology Oncology Division Hammoud Hospital University Medical Center Saida Lebanon Tel: +961 3 753 155 E-Mail: drfadi@drfadi.org
More informationRenal function vs chemotherapy dosing
Renal function vs chemotherapy dosing Jenny Casanova Senior Clinical Pharmacist Repatriation General Hospital Daw Park 1 Methods of estimating renal function Cockcroft-Gault (1976) C-G using ideal vs actual
More informationGOOVIPPC. Protocol Code: Gynecology. Tumour Group: Paul Hoskins. Contact Physician: James Conklin. Contact Pharmacist:
BCCA Protocol Summary for Primary Treatment of Stage III less than or equal to 1 cm Visible Residual Invasive Epithelial Ovarian Cancer or Stage I Grade 3 or Stage II Grade 3 Papillary Serous Ovarian Cancer
More informationEssentials. Oncology Practise Essentials. Oncology Basics. Tutorial 2. Cancer Chemotherapy
Practise Practise This tutorial introduces you to the history, goals of therapy, classification, and clinical uses of chemotherapy. It also reviews some of the barriers to successful therapy. Goals and
More informationGUIDELINES FOR ANTIEMETIC USE IN ONCOLOGY SUMMARY CLASSIFICATION
GUIDELINES FOR ANTIEMETIC USE IN ONCOLOGY SUMMARY More than half of all cancer patients experience nausea or vomiting during the course of their treatment. If nausea or vomiting becomes severe enough,
More informationBRAJACTT. Protocol Code. Breast. Tumour Group. Dr. Karen Gelmon. Contact Physician
BC Cancer Protocol Summary for Adjuvant Therapy for Breast Cancer using DOXOrubicin and Cyclophosphamide followed by PACLitaxel and Trastuzumab (HERCEPTIN) Protocol Code Tumour Group Contact Physician
More informationBRAJACTTG. Protocol Code. Breast. Tumour Group. Dr. Karen Gelmon. Contact Physician
BC Cancer Protocol Summary for Adjuvant Therapy for Breast Cancer Using Dose Dense Therapy: DOXOrubicin and Cyclophosphamide Followed by PACLitaxel and Trastuzumab (HERCEPTIN) Protocol Code Tumour Group
More informationOptimizing Drug Regimens in Cancer Chemotherapy
Optimizing Drug Regimens in Cancer Chemotherapy A. ILIADIS, D. BARBOLOSI Department of Pharmacokinetics, Faculty of Pharmacy University of Méditerranée 27, bld. Jean Moulin, 13385 Marseilles Cedex 5 FRANCE
More informationBCCA Protocol Summary for Adjuvant Therapy for Breast Cancer Using Fluorouracil, Epirubicin and Cyclophosphamide and DOCEtaxel
BCCA Protocol Summary for Adjuvant Therapy for Breast Cancer Using Fluorouracil, Epirubicin Cyclophosphamide DOCEtaxel Protocol Code Tumour Group Contact Physician BRAJFECD Breast Dr. Stephen Chia ELIGIBILITY:
More informationBasic Pharmacokinetic Principles Stephen P. Roush, Pharm.D. Clinical Coordinator, Department of Pharmacy
Basic Pharmacokinetic Principles Stephen P. Roush, Pharm.D. Clinical Coordinator, Department of Pharmacy I. General principles Applied pharmacokinetics - the process of using drug concentrations, pharmaco-kinetic
More informationR-GDP: Rituximab, Gemcitabine, Dexamethasone &Cisplatin
: Rituximab, &Cisplatin INDICATION Relapsed or refractory Hodgkin and non-hodgkin lymphoma. Omit Rituximab for patients with Hodgkin Lymphoma. TREATMENT INTENT Palliative or curative depending on context.
More informationZzbeacon,Zayna [MR ]
AALL1131 INTERIM MAINTENANCE, HR-ALL, ARM B, HD MTX Properties Cycle 1 9/27/2012 through 11/28/2012 (63 days), Planned Day 1, Cycle 1 Planned for 9/27/2012 Release CBC and differential Release Release
More informationGuidelines on Chemotherapy-induced Nausea and Vomiting in Pediatric Cancer Patients
Guidelines on Chemotherapy-induced Nausea Vomiting in Pediatric Cancer Patients COG Supportive Care Endorsed Guidelines Click here to see all the COG Supportive Care Endorsed Guidelines. DISCLAIMER For
More informationPalliative Low Grade Lymphoma & Hairy Cell Leukemia Regimens. Low Grade Lymphoma
Palliative Low Grade Lymphoma & Hairy Cell Leukemia Regimens The following table lists the evidence-informed regimens (both IV and non-iv) for low grade lymphoma and Hairy Cell leukemia used in the palliative
More informationCD20-positive high-grade non-hodgkin Lymphoma in patients in which R-CHOP is not indicated
INDICATION CD20-positive high-grade non-hodgkin Lymphoma in patients in which R-CHOP is not indicated TREATMENT INTENT Curative or Disease Modification. PRE-ASSESSMENT 1. Ensure histology is confirmed
More informationCisplatin + Etoposide IV / Oral therapy followed by Chemo-radiotherapy in Small Cell Carcinoma of the Cervix
Cisplatin + Etoposide IV / Oral therapy followed by Chemo-radiotherapy in Small Cell Carcinoma of the Cervix Indication: Neoadjuvant chemotherapy followed by Chemo-radiotherapy in Small Cell Carcinoma
More informationULYRICE. Protocol Code. Lymphoma. Tumour Group. Dr. Laurie Sehn. Contact Physician
BCCA Protocol Summary for the Treatment of Relapsed or Refractory Advanced Stage Aggressive B-Cell Non-Hodgkin s Lymphoma with Ifosfamide, CARBOplatin, Etoposide and rituximab Protocol Code Tumour Group
More informationCARBOplatin (AUC1.5) Chemoradiation Therapy-7 days
CARBOplatin (AUC1.5) Chemoradiation Therapy-7 days INDICATIONS FOR USE: Regimen Code INDICATION ICD10 Chemoradiation commencing 3 to 8 weeks after the completion of induction chemotherapy with TPF in patients
More informationNCCP Chemotherapy Regimen
Carboplatin (AUC 2) Weekly and Paclitaxel (50mg/m 2 ) Weekly with Radiotherapy (RT) -5 weeks INDICATIONS FOR USE: Regimen Code 00422a *Reimbursement Indicator INDICATION ICD10 Preoperative chemoradiation
More informationStandardization of the Body Surface Area (BSA) Formula to Calculate the Dose of Anticancer Agents in Japan
Jpn J Clin Oncol 2003;33(6)309 313 Standardization of the Body Surface Area (BSA) Formula to Calculate the Dose of Anticancer Agents in Japan Tsutomu Kouno, Noriyuki Katsumata, Hirofumi Mukai, Masashi
More informationCarboplatin / Liposomal Doxorubicin CARBO/CAELYX Gynaecological Cancer
Systemic Anti Cancer Treatment Protocol Carboplatin / CARBO/CAELYX Gynaecological Cancer PROCTOCOL REF: MPHAGYNCCX (Version No: 1.0) Approved for use in: Advanced ovarian cancer in women who have progressed
More informationChapter 5 Stage III and IVa disease
Page 55 Chapter 5 Stage III and IVa disease Overview Concurrent chemoradiotherapy (CCRT) is recommended for stage III and IVa disease. Recommended regimen for the chemotherapy portion generally include
More informationVIP (Etoposide, Ifosfamide and Cisplatin)
VIP (Etoposide, Ifosfamide and Cisplatin) Indication First line treatment for metastatic seminoma, non seminoma or combined tumours where bleomycin is contra-indicated. Usually used for patients with intermediate
More informationVan Cutsem E et al. Proc ASCO 2009;Abstract LBA4509.
Efficacy Results from the ToGA Trial: A Phase III Study of Trastuzumab Added to Standard Chemotherapy in First-Line HER2- Positive Advanced Gastric Cancer Van Cutsem E et al. Proc ASCO 2009;Abstract LBA4509.
More informationCisplatin / Paclitaxel Gynaecological Cancer
Systemic Anti Cancer Treatment Protocol Cisplatin / Paclitaxel Gynaecological Cancer PROCTOCOL REF: MPHAGYNCIP (Version No: 1.0) Approved for use in: First line treatment for stage Ib-IV with minimal residual
More informationFoROMe Lausanne 6 février Anita Wolfer MD-PhD Cheffe de clinique Département d Oncologie, CHUV
FoROMe Lausanne 6 février 2014 Anita Wolfer MD-PhD Cheffe de clinique Département d Oncologie, CHUV Epithelial Ovarian Cancer (EOC) Epidemiology Fifth most common cancer in women and forth most common
More informationTriple Negative Breast Cancer. Eric P. Winer, MD Dana-Farber Cancer Institute Harvard Medical School Boston, MA October, 2008
Triple Negative Breast Cancer Eric P. Winer, MD Dana-Farber Cancer Institute Harvard Medical School Boston, MA October, 2008 Triple Negative Breast Cancer 15% 25% Triple Negative 20% HER2+ ER+ Low Grade
More informationRESEARCH ARTICLE. Kuanoon Boupaijit, Prapaporn Suprasert* Abstract. Introduction. Materials and Methods
RESEARCH ARTICLE Survival Outcomes of Advanced and Recurrent Cervical Cancer Patients Treated with Chemotherapy: Experience of Northern Tertiary Care Hospital in Thailand Kuanoon Boupaijit, Prapaporn Suprasert*
More informationR-GDP: Rituximab, Gemcitabine, Dexamethasone &Cisplatin
: Rituximab, Gemcitabine, Dexamethasone &Cisplatin INDICATION Relapsed or refractory Hodgkin and non-hodgkin lymphoma. Omit Rituximab for patients with Hodgkin Lymphoma or high grade T cell non-hodgkin
More informationAcute Lymphoblastic Leukemia (ALL) Ryan Mattison, MD University of Wisconsin March 2, 2010
Acute Lymphoblastic Leukemia (ALL) Ryan Mattison, MD University of Wisconsin March 2, 2010 ALL Epidemiology 20% of new acute leukemia cases in adults 5200 new cases in 2007 Most are de novo Therapy-related
More information(R) CODOX M / (R) IVAC
(R) CODOX M / (R) IVAC Indication Burkitt's or Burkitt's-like lymphoma, especially those with 1 or more of the following poor risk criteria: - Raised LDH level - WHO performance status 2-4 - Ann Arbor
More informationCarboplatin and Gemcitabine
Systemic Anti Cancer Treatment Protocol Carboplatin and Gemcitabine PROTOCOL REF: MPHACAGELU (Version No: 1.0) Approved for use in: Advanced non-small cell lung cancer Performance status: 0 to 2 Re-challenge
More informationZzbeacon,Zayna [MR ]
AALL1131-DS INDUCTION HR-ALL, DAYS 1-14 Properties Cycle 1 9/27/2012 through 10/10/2012 (14 days), Planned Day 1, Cycle 1 Planned for 9/27/2012 Release Labs CBC and differential Release Release Comprehensive
More information1. If the MTC is 100 ng/ml and the MEC is 0.12 ng/ml, which of the following dosing regimen(s) are in the therapeutic window?
Page 1 PHAR 750: Biopharmaceutics/Pharmacokinetics October 23, 2009 - Form 1 Name: Total 100 points Please choose the BEST answer of those provided. For numerical answers, choose none of the above if your
More informationNCCP Chemotherapy Regimen. Dose Dense DOXOrubicin, Cyclophosphamide (AC 60/600) 14 day followed by PACLitaxel (80) 7 day Therapy (DD AC-T)
Dose Dense DOXOrubicin, Cyclophosphamide (AC 60/600) 14 day followed by PACLitaxel (80) 7 day Therapy (DD AC-T) INDICATIONS FOR USE: INDICATION Adjuvant Treatment of High Risk Node Negative or Node Positive
More informationSelected Clinical Calculations Chapter 10. Heparin-Dosing calculations
Selected Clinical Calculations Chapter 10 Heparin-Dosing calculations Heparin is a heterogeneous group of muco-polysaccharides that have anticoagulant properties (slows clotting time). Heparin salt, as
More information13/12/26. Febrile Neutropenia (FN) Febrile Neutropenia in 523 Dogs with Various Malignant Tumors. Methods. Our study objective.
The 3 rd Asian Meetings Animal Medicine Specialties 2013 Febrile Neutropenia (FN) Febrile Neutropenia in 523 Dogs with Various Malignant Tumors Fukiko Oshima 1), Tetsuya Kobayashi 1), Eri Fukazawa 1) Yuko
More informationClinical Policy: Nabilone (Cesamet) Reference Number: ERX.NPA.35 Effective Date:
Clinical Policy: (Cesamet) Reference Number: ERX.NPA.35 Effective Date: 09.01.17 Last Review Date: 08.18 Revision Log See Important Reminder at the end of this policy for important regulatory and legal
More informationZzbeacon,Zayna [MR ]
AALL1131 MAINTENANCE, ARM B, HR-ALL Properties Laboratory and Take-Home Medications 9/26/2012, Planned Laboratory and Take-Home Medications Planned for 9/26/2012 Release Take-Home Medications prednisone
More informationPoor-prognostic advanced Germ Cell Tumors
14-10-16 Poor-prognostic advanced Germ Cell Tumors Karim Fizazi, MD, PhD Institut Gustave Roussy, France Metastatic GCT: Prognosis (IGCCC) Good prognosis Intermediate prognosis Poor prognosis J Clin Oncol
More informationDERBY-BURTON LOCAL CANCER NETWORK FILENAME ESHAP.DOC CONTROLLED DOC NO: HCCPG B44. ESHAP Regimen
ESHAP Regimen Available for Routine Use in Burton in-patient Derby in-patient Burton day-case Derby day-case Burton community Derby community Burton out-patient Derby out-patient Indication Relapsed/ refractory
More informationPolicy for Central Nervous System [CNS] Prophylaxis in Lymphoid Malignancies
Policy for Central Nervous System [CNS] Prophylaxis in Lymphoid Malignancies UNCONTROLLED WHEN PRINTED Note: NOSCAN Haematology MCN has approved the information contained within this document to guide
More informationCisplatin and Gemcitabine Bladder Cancer: Full and split dose
Systemic Anti Cancer Treatment Protocol Cisplatin and Gemcitabine Bladder Cancer: Full and split dose PROCTOCOL REF: MPHAUROCIG (Version No: 1.0) Approved for use in: Neoadjuvant and palliative indications
More information